The first sentence is your answer. The third word even.
The healthcare market. MARKET
Healthcare shouldn't be a market. That's why you're paying $40k.
The healthcare market. MARKET
Healthcare shouldn't be a market. That's why you're paying $40k.
Healthcare in the United States isn't a market, and that is why it is so terrible. For instance, there is no reasonable ability to compare prices of services. Prices are entirely hidden. Then there is the "with insurance" price vs cash prices.
Healthcare doesn't function as a market, to our detriment.
There is no universe in which it doesn't cost around $10,000. None. It is simply impossible for me to get out of paying that. My options are:
1. Use insurance, and hopefully it's covered.
2. Pay out of pocket.
3. Skip it and hope I don't die.
That's it, those are my options. I can't "shop around" for this, and I shouldn't have to. This is basic medical care available to everyone in a developed nation. Ours is the only one for whom this is apparently an intractable problem, and I am, frankly, tired of being gaslit about it.
My routine blood work done via my doctor bills something like $1600 to my insurance every other year or so - but it do it on my own outside of the medical system for about $180 every six months.
No one should have to do this for necessary care - but once you get into things not typically covered by insurance like plastic surgery or LASIK the true costs are generally rather reasonable.
A whole shadow ecosystem for “health hackers” or whatever you might want to call it exists where standard medical stuff is 10% of the cost if paid out of pocket and through alternative prescribers. It’s a small subset of all available medical items, but the difference in true cost is illuminating.
It really is two separate questions how much basic procedures should cost. But I see no reason why non-urgent even important care shouldn't operate like real market. Open prices where competition is either on those prices or quality of care.
In other areas, like heart attacks and strokes, you do not get to shop around. And you pay whatever they say you will pay. When those are the circumstances, there is simply no free market. And since no one is competing for your business with lower prices in that case, you do not get to see lower prices. They charge whatever they can maximally wring out of you.
Hence why the US already has government healthcare that covers almost half the population (Medicaid and Medicare cover the old, young, disabled, veterans, and poor people).
However, the place you give birth is, in the vast majority of cases, something people do like to have agency over, especially given the 9 months of heads up given by nature.
If healthcare weren't so perversely incentivized by the twisted triangle of regulated public/employer/private systems and their interactions, I would argue this is something that could be a functioning market.
Like Universities with their endless ability to raise prices due to the US government guaranteeing student loans of any size to anyone, a big problem in healthcare is there being no anchor to reality due to the principle-agent nightmares of the current regulated system.
In Europe, when you give birth it is not a luxury experience with a doctor of your choosing in a 4-5 star level private room where you're sent home with a big basket of freebies. If all Americans had to pay directly out-of-pocket (as Europeans de-facto do via taxation), you can bet reality would set in quick.
(This is frequently the case for my wife.)
They may also not take Medicaid patients; my state publishes lists of ones that actually do because of this. https://www.health.ny.gov/health_care/medicaid/quality/surge...
(And even in the case of a surgical center, your decision is likely to be significantly impacted by who your insurer will agree to cover.)
lol..
Dr Evil in the time you've been in cryostasis...
Recent legal changes have made pricing more transparent. In 2020, the federal government issued the "transparency in coverage" final rule under the Federal No Surprises Act. This limited the expenses for emergency care when out-of-network and a few other things, but even more exciting is that hospitals and insurers are now required to publish a comprehensive machine-readable file with ALL items and services. They have to provide all negotiated rates and cash prices for the services and include a display of "shoppable" services in a consumer-friendly format. The machine-readable files are impractical to process yourself for comparison shopping (picture: different formats, horribly de-normalized DB dumps), but many sites and APIs have emerged to scrape them and expose interfaces to do so.
Healthcare has to be rationed. Rationing by market is the least bad kind of we learn anything from history... Too bad healthcare in the US is not a market in any way or form, and in fact the most expensive least DALY efficient interventions (Medicare) are subsidized at the expense of everything else.
In a society that values McDonald's staying cheap and Coca-Cola superbowl ads, maybe this is true, but it's not a universal rule at all. On the other end of the spectrum from kidney transplants are regular checkups and ability to walk into any doctor's office to get your flu/cold checked out. Rationing healthcare at these stages is only going to make it worse as people wait until they need an emergency room visit to get care.
The US "market" is between the drug companies, hospitals, practitioners' groups, insurance companies, and government.
They are the ones that have market participation, the patient's not involved with that, their primary duty is to provide justification for the transaction.
>Healthcare doesn't function as a market, to our detriment.
So true, but even worse than that, the market that is there is predatory to a cumulative detriment worse than when simply dropping the ball makes things go wrong :\
I see your drill down to fundamental issues and I raise you:
Pregnancy is not a sickness. Hospitals are for sick people.
If we reserved hospital birth for women and children with actual medical problems we would allocate resources much more judiciously.
An added benefit: not exposing otherwise healthy (and capable) women to an almost universally disempowering and disenfranchising birth-industrial-complex that seems designed to engender fear, self-doubt and pathological outcomes.
Government loves anything that assists its people-tracking machinery. It will never ever ever discourage pregnant women from doing something that would make reliable Enumeration At Birth more difficult.
As fun as it sounds to go back to 25-50% infant mortality, I would prefer we keep this in hospitals and do cesarian sections and other interventions when necessaru.
It's also very expensive to be underdeveloped. Simple things go from given to impossible problems. Things we take for granted, like sanitation, because insurmountable obstacles. Just ask any developing countries.
Less infant mortality is good, actually, because I like living in a developed country. I don't want to burn our tax payer dollars on burning baby corpses. I don't want to burn tax payer dollars on a stupidly volatile economy because everyone is dying all the time.